Macular hole surgery: experience with autologous platelet concentrate and indocyanine green-assisted internal limiting membrane peeling

BACKGROUND: To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. PATIENTS AND METHODS: Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 +/- 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 +/- 0,1 x 10(8) thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. RESULTS: After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. CONCLUSION: Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling     

Laparoscopy in the surgical treatment of rectal cancer in Germany 2000–2009

Aim The goal of this registry study was to compare open surgery with planned laparoscopy and then with laparoscopic to open conversion for rectal cancer surgery. Method The study included 17 964 rectal cancer patients, operated on between 1 January 2000 and 31 December 2009, from 345 hospitals in Germany. All statistical tests were two‐sided, with the χ² test (Pearson correlation) for patients and tumour characteristics. Fisher’s exact test was used for complications and 30‐day mortality. Results Of the 17 964 rectal cancer patients, 16 308 (90.8%) had an open procedure and 1656 (9.2%) were started with a laparoscopy. The 1455 patients with completed laparoscopic operations had fewer intra‐operative and postoperative complications (5.4%vs 7.0%, P = 0.020, and 20.5%vs 25.8%, P < 0.001, respectively) and a lower 30‐day mortality rate (1.1%vs 1.9%, P = 0.023). Of the 1656 planned laparoscopies, 201 (12.1%) were converted to open. The converted group suffered more intra‐operative complications (18.9%vs 3.6% for completed laparoscopy and 7.0% for open surgery, P < 0.0001) and postoperative complications (32.3%vs 18.9% for completed laparoscopy and 25.8% for open operations, P < 0.0001). The converted group also had a higher 30‐day mortality rate (2.0%vs 1.0% for completed laparoscopy and 1.9% for open surgery, P = 0.043). Conclusion The more favourable patient profile provided justification for a laparoscopic procedure. For those converted to an open procedure, however, there were significantly more complications than planned open surgery patients. A move away from the standard open procedure for rectal cancer surgery and towards laparoscopy is not yet feasible.     

Terminal complement complex in septic shock with capillary leakage: marker of complement activation?

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the value of terminal complement complex (C5b-9) plasma levels as a marker for complement activation in septic shock with concomitant capillary leak syndrome. METHODS: In a prospective animal study 10 fasted, anaesthetized, mechanically ventilated and multi-catheterized pigs (20.6 +/- 1.3 kg) were investigated over a period of 8 h. Sepsis was induced by faecal peritonitis (1 g kg(-1) body weight faeces, n = 5) and compared to controls (n = 5). The animals received 6% hydroxyethyl starch 200/0.5 to maintain a central venous pressure of 12 mmHg. To quantify capillary leak syndrome, albumin escape rate was measured using 99mTc-labelled human serum albumin. Plasma levels of terminal complement complex were measured in a double antibody immunoassay (neoepitope-specific MoAb aE 11 as catching antibody). Immunohistological studies of renal specimens were performed to detect terminal complement complex deposition. RESULTS: Albumen escape rate increased in septic animals (+ 52%) compared to controls (+ 3%, P < 0.05). Plasma levels of terminal complement complex decreased during the study period in both groups. In septic animals this finding was accompanied by a significant deposition of terminal complement complex in renal specimens (P < 0.05). CONCLUSION: We found an activation of the complement system proven by marked deposition of terminal complement complex in renal specimen, while its plasma levels decreased during the study period in septic and control animals. These results suggest that in septic shock with capillary leak syndrome plasma level of terminal complement complex may not be a reliable marker of complement activation.     

How Depressive Symptoms Hinder Positive Information Processing: An Experimental Study on the Interplay of Cognitive Immunisation and Negative Mood in the Context of Expectation Adjustment

Background

People with depression maintain negative expectations despite disconfirming positive experiences by reappraising or discarding novel positive information, referred to as “cognitive immunisation”. A second body of literature suggests that negative mood can negatively affect information processing. Bridging these two lines of research, the present study examined the interplay of cognitive immunisation and negative mood in the context of expectation modification.

Methods

In a student sample (N?=?152), we used a well-established experimental paradigm to examine the adjustment of performance expectations in response to positive performance feedback, and its relation to depressive symptoms. In a 2?×?2 design, participants received either a negative mood induction, a cognitive immunisation manipulation, both, or no further manipulation.

Results

Participants from all experimental groups revised their previous expectations significantly in line with positive performance feedback. However, depressive symptoms were a negative predictor of expectation adjustment, and a moderation analysis indicated that this effect was particularly pronounced if participants underwent the negative mood induction.

Conclusions

Consistent with previous work, depressive symptoms were associated with a reduced ability to integrate positive information. Furthermore, our results suggest that the activation of negative mood in people with elevated levels of depression may hamper learning from new positive experience.